Experts worry California will be blacklisted from federal homelessness dollars, effectively counteracting recent progress.

On this weeks episode of As Prescribed, Alice Wertz spoke with Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF about the aging homeless population. Older people who experience homelessness tend to have health problems more commonly found in people who are in their 70s or 80s. Recent research has shown that about 48% of adults experiencing homelessness were 50 and above. "They really were hanging on every month, scraping by, barely able to make the rent,” said Dr. Kushel. “And sometime after the age of 50, something happened. And what was really interesting about these folks, as they could kind of pinpoint the moment when things fell apart.” she added.

Margot Kushel, MD, a professor of medicine at University of California San Francisco, who leads the UCSF Benioff Homelessness and Housing Initiative, also said there’s little evidence of correlation between mental health and homelessness. Instead, she said the places with highest homelessness have a split population of high earners who can afford to pay housing costs, and those who can’t, competing for a limited supply of housing. Think: San Francisco. Dr. Kushel recently conducted a study in which researchers approached the 400 most chronically homeless people in Santa Clara and offered them a permanent home. All but one said yes.

America’s homeless population swelled to its highest level in recorded history in 2024 according to an annual count of individuals living in emergency shelters, transitional housing or on the streets. California continues to have the largest homeless population of any state — 187,084 in 2024 — and the highest rate of unsheltered people, according to the U.S. Department of Housing and Urban Development’s point-in-time estimate released Friday, December 27, 2024. However, California's increase of 3.1% from 2023 was smaller relative to other states.

On the second day of the CalMatters Ideas Festival panelists discussed homelessness solutions, moderated by Marissa Kendall. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and Robynne Rose-Haymer, one of the CASPEH Lived Expertise Advisory Board members, were panelists. Ms. Rose-Haymer said, "By rooting people out forcibly, it does nothing to build that trust, and in fact, harms the very services that we are paying billions of dollars to stand up."

In a cohort of over 100,000 patients who received care from the Department of Veterans Affairs (VA) health system, those experiencing homelessness were more likely to be diagnosed with stage IV colorectal cancer compared with those who had housing. The patients who experienced homelessness also had longer hospital stays for all the cancer types studied. However, the findings differed across healthcare settings. In a commentary accompanying the study, Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, said "Reducing healthcare disparities for people experiencing homelessness is essential, and the [VA] can serve as an example of what it takes to do so."

In this retrospective observational cross-sectional study of patients in the Trauma Quality Improvement Program (TQIP), researchers looked to determine if there was significant practice variability in adoption of alcohol and drug screening of injured patients among hospitals participating in TQIP. Researchers found that overall rates of recommended alcohol and drug screening of injured patients were low and varied significantly between hospitals.

Caitlin Carey, PhD, a post-doctoral scholar at the UCSF Benioff Homelessness and Housing Initiative, spoke about how hostile architecture, which refers to design features created specifically to deter unhoused people from finding somewhere to sleep, harms people experiencing homelessness.

A new study from UCSF Benioff Homelessness and Housing Initiative and the San Francisco Department of Public Health describes how San Francisco rapidly scaled a hotel-based isolation and quarantine (I/Q) system of care for people experiencing homelessness during the COVID-19 pandemic. Researchers found the program safely delivered integrated medical and behavioral health support to more than 1000 individuals outside the hospital setting, while helping to preserve hospital capacity.

Researchers from UCSF Benioff Homelessness and Housing Initiative and the San Francisco Department of Public Health found that housing homeless residents with mild to moderate COVID-19 in hotel rooms lowered the burden on hospitals overwhelmed with more seriously ill patients. The findings, published in JAMA Network Open, underscore the public health benefits of providing stable housing and services to those who need them most.

The Terner Center for Housing Innovation has issued a new report looking at the pressures that force extremely low-income households in the Bay Area to the edge of homelessness. Policy manager Ned Resnikoff looks at what the report has to say about how income disparities contribute to the region's crisis of housing affordability.

Dr. Kushel shares compelling insights from her three decades of clinical practice and research, revealing how the lack of affordable housing creates impossible situations for healthcare providers trying to treat patients experiencing homelessness. From managing diabetes in a tent to storing insulin without refrigeration, she illustrates why "there is no medicine as powerful as housing."

In 2024, for the second year in a row, a record number of people in the U.S. experienced homelessness on a single night, according to the U.S. Department of Housing and Urban Development (HUD). The homelessness crisis is fueled by skyrocketing housing costs, which have put homes out of reach for hundreds of thousands of people. Nearly half of renters spend more than 30 percent of what they make on housing, according to the Census Bureau. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "They’re not spending it on food. They’re not spending it on health care. They’re not putting it away for a rainy day."

In this op-ed, Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, highlights the cruelty and counterproductive policies in light of the US Supreme Court's ruling in City of Grants Pass v. Johnson. She outlines the systemic issue of state and local governments punishing people who experience homelessness and calls for fixing the affordable housing problem. "It is now up to us to insist that our local and state officials instead enact policies that will end homelessness by providing safe, secure and affordable housing for all of us." Dr. Kushel writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Much of BHHI’s work is rooted in a simple premise: The solution to homelessness is housing. While lack of a permanent home is not the only challenge facing most unhoused people, it is the one challenge they all have in common. And whatever other challenges they may have—whether they include persistent unemployment, physical disability, mental illness, or none of the above—are significantly harder to manage for people who are simultaneously dealing with the stress of homelessness. Giving people homes creates the conditions necessary for them to heal and flourish.

As part of the National Low Income Housing Coalition's (NLIHC) Housing First Promotes Health call in February 2023, Margot Kushel, MD, director of the UCSF Benioff Housing and Homelessness Initiative, shared research on how housing improves health outcomes.

Deep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. In this study, researchers aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes. They found that the high prevalence of housing instability and mental health challenges among low-income Black young adults require tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.

In this podcast, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, explains the country’s rise in homelessness and the critical impact of housing on the health needs of vulnerable populations.

Housing is a primary social determinant of health and a new study published in Health Affairs shows that lung and colorectal cancer mortality was higher among veterans who were unhoused compared to those who were housed. Hannah C. Decker, MD, of the University of California, San Francisco and lead author, and her colleagues suggest that "adopting the VA’s strategies in other settings where people without housing seek care, particularly for patients diagnosed with cancer, may help improve outcomes in this vulnerable population."

Housing is linked to lower cancer mortality in US veterans, a recent study found. Hannah C. Decker, MD, of the University of California, San Francisco and lead author of the study, spoke about the study, the pervasiveness of veteran homelessness, and how homelessness affects health. Dr. Decker said, "We are really interested is getting a deeper understanding of how the VA gets veterans into housing, especially those that are diagnosed with serious chronic diseases, like cancer."

In this op-ed, Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, calls for housing to be a human right. She outlines how having a home remains a privilege and the lack of resources to compete in the housing market displaces people into homelessness. Dr. Ponder writes, "Housing is a vital standard of humanity." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Homelessness is associated with poor outcomes following cancer diagnosis. In this retrospective cohort study, researchers examined the association between housing status and acute care in adult patients treated for cancer at Zuckerberg San Francisco General Hospital. Researchers found that among patients receiving treatment for cancer at an urban public hospital, acute care use increased disproportionately in unhoused patients in the year of diagnosis, while psychiatric acute care use did not change.